Appointment Request

In order to schedule an appointment, fill out the below form, and it will send a request to Dr. Samaniego. She will get back to you as soon as she is able to finalize the scheduling of your appointment.

  • MM slash DD slash YYYY
    By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.